Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Interventional Cardiology, Department of Medicine, University Health Network, Toronto, Ontario, Canada.
Can J Cardiol. 2024 Sep;40(9):1732-1741. doi: 10.1016/j.cjca.2024.03.028. Epub 2024 Apr 10.
Severe lung disease frequently presents with both refractory hypoxemia and right ventricular (RV) failure. Right ventricular assist device with an oxygenator (OxyRVAD) is an extracorporeal membrane oxygenation (ECMO) configuration of RV bypass that also supplements gas exchange. This systematic review summarises the available literature regarding the use of OxyRVAD in the setting of severe lung disease with associated RV failure.
PubMed, Embase, and Google Scholar were queried on September 27, 2023, for articles describing the use of an OxyRVAD configuration. The main outcome of interest was survival to intensive care unit (ICU) discharge. Data on the duration of OxyRVAD support and device-related complications were also recorded.
Out of 475 identified articles, 33 were retained for analysis. Twenty-one articles were case reports, and 12 were case series, representing a total of 103 patients. No article provided a comparison group. Most patients (76.4%) were moved to OxyRVAD from another type of mechanical support. OxyRVAD was used as a bridge to transplant or curative surgery in 37.4% and as a bridge to recovery or decision in 62.6%. Thirty-one patients (30.1%) were managed with the dedicated single-access dual-lumen ProtekDuo cannula. Median time on OxyRVAD was 12 days (interquartile range 8-23 days), and survival to ICU discharge was 63.9%. Device-related complications were infrequently reported.
OxyRVAD support is a promising alternative for RV support when gas exchange is compromised, with good ICU survival in selected cases. Comparative analyses in patients with RV failure with and without severe lung disease are needed.
严重肺部疾病常伴有难治性低氧血症和右心室（RV）衰竭。带氧合器的右心室辅助装置（OxyRVAD）是一种 RV 旁路的体外膜肺氧合（ECMO）配置，也可补充气体交换。本系统评价总结了关于在严重肺部疾病伴 RV 衰竭的情况下使用 OxyRVAD 的现有文献。
2023 年 9 月 27 日，在 PubMed、Embase 和 Google Scholar 上检索描述 OxyRVAD 配置使用的文章。主要观察终点为 ICU 出院存活率。还记录了 OxyRVAD 支持的持续时间和与器械相关的并发症的数据。
在 475 篇已确定的文章中，有 33 篇被保留用于分析。21 篇是病例报告，12 篇是病例系列，共涉及 103 例患者。没有文章提供了对照组。大多数患者（76.4%）从另一种机械支持转为使用 OxyRVAD。37.4%的患者使用 OxyRVAD 作为移植或根治性手术的桥梁，62.6%的患者使用 OxyRVAD 作为恢复或决策的桥梁。31 例患者（30.1%）采用了专用单入口双腔 ProtekDuo 套管。OxyRVAD 的中位使用时间为 12 天（四分位间距 8-23 天），ICU 出院存活率为 63.9%。与器械相关的并发症很少报道。
在气体交换受损时，OxyRVAD 支持是 RV 支持的一种有前途的替代方法，在选定的病例中 ICU 存活率较好。需要在伴有和不伴有严重肺部疾病的 RV 衰竭患者中进行比较分析。
